Health Promotion and Disease/Injury Prevention

Able to do Virtually

RN’s skills and expertise in public health and can engage patients effectively in these important conversations. They can deliver health promotion and preventive care programs to targeted populations in the practice. This can include counselling for falls prevention, sexual health, contraceptives, appropriate access to community resources, mental health, substance use, lifestyle, health screening, etc. Most counselling strategies can be delivered virtually.  Safety assessment and clinical judgement may inform need for in-person intervention.

RNs can also support the delivery of anticipatory care and supportive counselling crucial during isolation (including reviewing mental health and personal safety).

Not Able to Do Virtually

Some maneuvers, such as pelvic exam and cervical cancer screening (as per PHSA competencies) would require face to face visits.

Able to do Virtually

Missing

Able to Do Virtually with Modifications

Missing

Not Able to Do Virtually

Missing

Able to do Virtually

Immunization education and reviewing immunization status of patients, ensuring immunizations are current can all be completed virtually. This is particularly important in 2020 as patients have many questions about immunizations.

Also, the practice can establish a proactive, practice wide immunization review program, using the EMR to report who may be overdue for immunizations and establish a process for discussion and review with patients who should have routine immunizations. Ensuring all vaccines are up to date this year is particularly important

Not Able to Do Virtually

Administration of immunizations needs to be done in person. Structure the visits into two parts – the virtual pre-visit where all the education and preparation can be done and then a very focused and expedited face to face time for just the immunization (and monitoring post-administration) in a physically-distanced manner.

Able to do Virtually

Assessing TB exposure risk can be done virtually as can ordering chest x-rays for TB screening.  Also following up the chest x-ray results can be completed virtually.

Able to Do Virtually with Modifications

Reading TB skin tests could be done virtually but this is not recommended as induration is measured, not redness. See TB guidelines.

Not Able to Do Virtually

Administration of TB skin tests requires face to face encounter; however, chest x-ray may be a suitable alternative.

Able to do Virtually

Much of a well child visit can be completed virtually prior to seeing the patient. These visits are a key component to ensure healthy growth and development as well as connecting with and providing support to parents. This is particularly important with the added stresses of social isolation of a pandemic. Spending time virtually with parents and children is important and much of the history and assessment can be done virtually

Able to Do Virtually with Modifications

A limited amount of physical assessment can be done virtually (e.g. with video, parents weighing older children) but physical exam of children is important and the history may direct to the need for in person assessment. This is particularly true for newborns and young children, where in person physical exam is more likely to be needed (e.g. weights, assessing latch, etc.).

Not Able to Do Virtually

Administration of immunizations would require in person visit. These visits can be streamlined with a virtual pre-visit to answer parents’ questions, coach on how to dress the child, etc.

Able to do Virtually

RNs can be integral to virtual perinatal counselling, assessment, and referrals where needed. Some of these can be done virtually, as well as providing support, answering specific questions.

Not Able to Do Virtually

While counselling and coordination can be done virtually, most of the physical assessment will require an in-person visit.

Able to do Virtually

Contraception options counselling, education, and referrals if indicated (e.g. for IUD) can all be provided virtually to patients. This can include comprehensive assessment of contraception management, including informed consent, health history, physical assessment, and proactive mental health screening

Able to Do Virtually with Modifications

While certified nurses are able to administer and/or dispense combined hormonal contraception and progestin-only hormonal contraception, this would have to be in person. All anticipatory counselling can be done virtually in a pre-visit with administration and or dispensing would require in-person visit.

Not Able to Do Virtually

Administration of injectable contraception would have to be in person.